When preparing for a baby, most birth plans focus heavily on labor, delivery, and immediate postpartum care. I certainly spend a good chunk of our time in PT talking about all of this. But if your baby arrives via C-section, recovery often gets simplified into two basic instructions: rest for six weeks and don’t lift anything heavier than your baby. Good luck. 

Once you get cleared at that 6-week postpartum checkup, it can feel like you’re expected to jump right back into normal life. However, a C-section is major abdominal surgery, and true recovery goes far beyond just waiting for an incision to close. Really, none of us are healed after birth at 6 weeks no matter how baby gets here but CERTAINLY not after a major surgery. 

Whether your C-section was planned or emergency, pelvic floor physical therapy (PFPT) is one of the most effective, yet underutilized, tools to help you heal fully, move without pain, and regain your core strength. While it should be standard of care it is still something that many providers don’t recommend to us after birth. 

Why C-Section Recovery Requires Pelvic PT

It’s a common misconception that pelvic floor issues only happen after a vaginal birth. In reality, your pelvic floor carries the weight of a growing baby for nine months regardless of how you deliver. Combine that pressure with a surgical incision through multiple layers of tissue, and your core system undergoes significant stress.

Here is how pelvic PT supports your recovery:

1. C-Section Scar Care & Mobility

During a C-section, the surgeon cuts through skin, fascia, and abdominal tissues to reach the uterus. As these layers heal, scar tissue forms. If that scar tissue grows rigid, it can restrict movement, pull on surrounding muscles, and cause pain far beyond the incision line.

• How PT helps: Pelvic physical therapists perform targeted scar tissue mobilization to break up adhesions. This improves skin mobility, reduces numbness or hypersensitivity around the scar, and prevents pulling sensations when you stand, stretch, or exercise.

2. Reconnecting Your “Core Canister”

Your deep core functions like a cylinder: your diaphragm is the top, your abdominal muscles wrap around the middle, and your pelvic floor forms the base. A C-section disrupts the abdominal wall, which can cause the pelvic floor to compensate by overworking or contracting too tightly.

• How PT helps: Rather than just telling you to do “crunches” or “kegels” (which can sometimes make tightness worse), a pelvic PT helps you retrain the deep transverse abdominis and pelvic floor muscles to work together in harmony again. It’s all about the coordination and breathing!!

3. Resolving “Invisible” Postpartum Symptoms

Many C-section parents are surprised to experience symptoms commonly associated with vaginal delivery. You don’t have to accept these issues as your “new normal”:

• Pain during intimacy
• Urinary urgency, frequency, or accidental leaking when laughing or sneezing
• Lower back, hip, or tailbone pain
• A feeling of pressure or heaviness in the pelvis

That’s where your Pelvic PT comes in – we look for the root cause and figure out how to make these symptoms better. 

4. Safely Returning to Exercise and Daily Life

Lifting a heavy infant seat, carrying groceries, or returning to workouts like running or weightlifting puts significant demand on your core and pelvic floor. Returning to heavy activity too quickly without proper core rehabilitation can lead to feeling pressure in your abdominal separation (diastasis recti), leaking, symptoms of prolapse and more. 

• How PT helps: Your therapist will assess your functional movement, check for diastasis recti, prolapse, weakness, etc.  and guide you through progressive exercises tailored to your specific fitness goals.

What to Expect at a Pelvic PT Appointment

If you’ve never been to pelvic PT, it’s natural to feel uncertain about what happens. I have a blog post about this if you want more detail but a typical session includes:

1. A Detailed History: Discussing your pregnancy, birth story, current pain points, bladder/bowel health, and personal goals.
2. External Assessment: Evaluating your posture, breathing patterns, core strength, hip mobility, and scar flexibility.
3. Internal Assessment (Optional): With your consent, an internal examination (via the vagina) may be performed to assess pelvic floor muscle tone, endurance, and strength.
4. Customized Treatment Plan: A mix of manual therapy, guided movement, breathing techniques, and targeted home exercises.

When Should You Start?

• Early Weeks (0–6 Weeks): Gentle diaphragmatic breathing, light walking, and gentle scar desensitization (lightly touching the surrounding skin) can begin early on.
• Post-Clearance (6+ Weeks): Once your OB-GYN or midwife clears you at your post-op visit, you can begin formal pelvic physical therapy.

Note: It is never “too soon” or ‘too late” to start. Whether you had a C-section six weeks ago or six years ago, scar tissue and pelvic floor dysfunction can still be successfully treated.

Give Your Body the Recovery It Deserves

You wouldn’t be expected to run a marathon right after knee surgery without rehabilitation—and recovering from a C-section should be treated no differently. Pelvic floor PT isn’t just about fixing problems; it’s about restoring confidence in your body’s ability to move, heal, and thrive in parenthood.

Pregnancy is an incredible experience, but let’s be honest… your body goes through A LOT. Having done it twice (once with twins) I am fully aware of how difficult, uncomfortable, and anxiety-provoking it can be.

As your baby grows, your body adapts in ways that can affect your posture, breathing, core strength, pelvic floor, and overall comfort. While some discomforts are considered common during pregnancy, that doesn’t mean you have to simply accept them as something you have to live with.

This is where pelvic floor physical therapy can make a meaningful difference.

Pelvic floor PT during pregnancy isn’t just about addressing problems after they happen. It’s about preparing your body, helping you feel more comfortable, and giving you the tools you need to navigate pregnancy, birth, and recovery with confidence.

What Exactly Is Pelvic Floor Physical Therapy?

I’ve covered this in other blog posts and on social media but we are the experts in all things pelvis. – specifically the muscles that support your pelvic organs, contribute to bladder and bowel control, assist with sexual function, and work together with your deep core and breathing muscles.

During pregnancy, your pelvic floor is adapting to:

• Increased weight and pressure from your growing baby
• Hormonal changes that affect your connective tissues
• Changes in posture and movement
• The physical demands of labor and delivery
• The recovery process after birth

Pelvic floor physical therapy focuses on how these muscles and surrounding areas are functioning—not simply whether they are strong.

Your pelvic floor needs to be able to contract, relax, lengthen, and coordinate with the rest of your body.

And every person’s needs during pregnancy are different. That’s why a one-size-fits-all online class is NOT going to be the best thing for YOUR specific needs!

5 Ways Pelvic Floor PT Can Help During Pregnancy

1. Reduce Pelvic and Low Back Pain

Pelvic girdle pain, low back pain, hip discomfort, and pubic symphysis pain can make everyday activities challenging. Getting in and out of the car, rolling over in bed, walking, exercising, or putting on your pants can suddenly feel much harder than it used to and can often cause pain. While it’s common, it’s not something you have to live with.

A pelvic floor physical therapist can assess how your pelvis, hips, core, breathing, and movement patterns are working together. Treatment may include:

• Personalized exercises to improve strength and coordination
• Movement modifications for daily activities
• Recommendations on supports or belts that can be helpful
• Hands-on techniques when appropriate
• Strategies to reduce strain during transitions and exercise

The goal is to help you move more comfortably and confidently throughout your pregnancy.

You don’t have to wait until pain is severe to seek help. In fact, it’s a LOT easier if you come in sooner!!!

2. Prepare Your Pelvic Floor for Birth

One of the most common misconceptions about the pelvic floor is that pregnancy preparation is all about strengthening it.

But here’s the thing: your pelvic floor needs to know how to relax, too. This is actually what we focus on in pelvic PT during pregnancy for the most part.

During a vaginal birth, the pelvic floor needs to lengthen and allow your baby to pass through the birth canal. Learning how to recognize tension, coordinate your breathing, and practice pelvic floor relaxation can be valuable skills.

We talk about better ways to push, positions for labor and delivery, movements to practice before and during labor and more. Pelvic floor therapy does not guarantee a specific birth outcome, but it can help you develop a better understanding of your body and prepare for the demands of delivery.

3. Address Bladder Leakage and Pelvic Pressure

Leaking when you cough, sneeze, laugh, change position can occur during pregnancy, but they deserve attention—not dismissal. While pregnancy places additional demands on the pelvic floor, leakage and pelvic pressure are not something you simply have to tolerate without support.

Sometimes there is a pressure management issue, other times it’s tight muscles. Sometimes it is weakness. That’s the beauty of having an actual human assess you instead of some of the online advice and classes out there – you don’t know what you’ll need until someone actually takes a look.

4. Keep You Moving and Exercising Safely

If you were active before pregnancy, you may want to continue doing the activities you enjoy. If you weren’t active, pregnancy can also be an opportunity to build a movement routine that feels good for your body.

Pelvic floor PT can help you adapt your exercise routine as your pregnancy progresses.

We talking things like:

• Strength training modifications
• Walking and other forms of exercise
• Core exercises and pressure management
• Managing symptoms during workouts
• Returning to movement after periods of discomfort

Your plan should be based on your symptoms, goals, stage of pregnancy, and medical considerations. You don’t have to stop moving just because your body is changing. You may simply need a different approach.

5. Prepare for Postpartum Recovery

One of my favorite things about seeing pregnant patients is the opportunity to start the conversation about postpartum recovery before the baby arrives.

Many women spend their entire pregnancy preparing for birth but have little guidance about what happens to their bodies afterward.

Pelvic floor PT can help you understand:

• What to expect during the early postpartum period
• How to gradually return to exercise
• How to manage changes in bladder and bowel function
• How to recognize symptoms that deserve additional support
• How to rebuild strength and coordination over time

The earlier you understand your body and have a plan, the more prepared you may feel to navigate the changes ahead.

When Should You Start Pelvic Floor PT During Pregnancy?

There is no single “perfect” week to begin but it is NEVER too soon or too late to come in! Some women benefit from an evaluation early in pregnancy, while others seek care when symptoms develop or as they prepare for birth.

You definitely want to consider pelvic floor PT if you are experiencing:

• Pelvic or low back pain
• Pain with walking, rolling in bed, or changing positions
• Urinary leakage
• Pelvic pressure or heaviness
• Pain with sexual activity
• Difficulty relaxing your pelvic floor
• Concerns about birth preparation
• Questions about exercise during pregnancy

Even if you aren’t experiencing symptoms, a preventative evaluation can help you understand your body and identify strategies that may support you throughout pregnancy and postpartum. I love getting to do PT sessions before birth even if it’s just once. It can be SO helpful!!

Always discuss new, severe, or concerning symptoms with your OB or midwife. Pelvic floor PT complements your prenatal medical care; it doesn’t replace it.

What Makes My Approach to Pelvic Floor PT Different?

I believe you deserve care that is individualized, unrushed, and centered around you. In my practice, I don’t believe in handing every pregnant woman the same exercise sheet and sending her on her way.

Your body, your pregnancy, your symptoms, and your goals are unique. Your treatment should reflect that. Because I run my practice a little differently I have the flexibility to focus on your individual concerns and spend time getting to know the whole picture—not just a diagnosis or a checklist of symptoms.

You Don’t Have to Wait Until Something Is Wrong

Pregnancy comes with enough uncertainty. You shouldn’t have to wonder whether pelvic pain, leakage, or discomfort is something you just have to push through.

Pelvic floor physical therapy can be a valuable part of your pregnancy journey, helping you prepare for birth, manage symptoms, and build a foundation for postpartum recovery.

You deserve to feel supported throughout every stage of pregnancy—not just after your baby arrives.

If you’re pregnant and wondering whether pelvic floor PT could be helpful for you, I’d love to help you explore your options!

If you’ve ever been to physical therapy through the traditional insurance-based model, you may have experienced the routine: you’re given a set amount of time, your therapist is juggling multiple patients, you’re working through a list of exercises, and just when you feel like you’re getting somewhere… your appointment is over. See you in two or three days. Over and over. For a good 6 to 8 weeks.

This doesn’t work well for Pelvic PT in my opinion.

As a pelvic floor physical therapist, I believe that meaningful care requires time, attention, and the ability to treat the whole person—not just a diagnosis or a collection of symptoms. I was getting really frustrated at not being able to treat a person’s ankle dysfunction because their PT script was for pelvic pain. Guess what – it’s all connected!!! The desperate need to shorten treatment times and add more patients to keep the lights on was getting exhausting.

That is why I am different.

One of the biggest differences you’ll notice is simply how much time we have together.

In my practice, your appointment isn’t designed around an insurance company’s rules about how many patients I can see or how many units I can bill. Instead, your time is focused on you. We have all the time to chat first, to get to know each other and to learn what is important to you. We can slow down. We can talk. We can ask questions. We can reassess. And we can spend the time necessary to understand what’s actually going on.

Because pelvic floor problems aren’t always straightforward. SHOCKER – they tend to involve things like hormonal changes, nutritional issues that impact your gut health, mental health issues that are impacting your body and more!! Who’d have thought? Umm, us women did. We KNOW that our bodies are complex and that everything is playing into how we feel on a daily basis.

You are not a diagnosis. There is more to your PT than what it says on a script. Two people can come to me with the same diagnosis and need completely different treatments. Uour history, lifestyle, goals, symptoms, movement patterns, pregnancy or postpartum experience, stress, activity level, and previous treatments all matter.

Rather than following a predetermined treatment plan, I build your care around what your body needs and what you want to get back to doing.

Pelvic floor symptoms don’t always originate where you feel them.

Pain, pressure, leaking, constipation, painful intercourse, abdominal discomfort, hip or back pain, and other pelvic floor symptoms can be influenced by the way your entire body moves and functions.

Having the time to look at the bigger picture allows me to investigate why you are experiencing your symptoms—not simply treat the symptom itself. This usually involves looking head to toe. Understanding how your feet, ankles, knees and hips are all playing into your pelvic floor. How your posture is impacting abdominal muscle function. How the fascia that connects to your organs is moving. ALL THE THINGS.

I don’t want you leaving your appointment thinking “what was the point of that?”

I want you leaving understanding your body. I want you to know why we’re doing something, what you’re working toward, and what you can do between appointments to continue making progress. I want you to feel able to reach out to me in between sessions, to ask questions when they pop into your head, to feel like I have your back even when you aren’t sitting in front of me. Not having to see 25 patients a day means you get so much more of me!

We are allowed to pivot if things aren’t working great. We are allowed to expand our treatment if your goals change. If you show up to my door with a headache instead of a pelvic ache we are able to shift our focus and get all of you feeling better without the restrictions.

There isn’t a limit on the number of sessions you have with me. There isn’t a certain date you have to be healed by. There aren’t a certain number of goals we are allowed to address at one time. It’s about you, your goals, your schedule. Period. The end.

I chose this model because I wanted to create the kind of physical therapy experience that I would want for myself or someone I love. If you’ve read my blog in the past you’ll know that I have been through my own journey through pelvic pain before every getting pregnant and then two postpartum journeys. I know what I wish I’d had back then.

A provider who didn’t make me feel like a number. A place where I could questions that weren’t “TMI.” Someone who felt like they actively cared about how I was feeling.

Ultimately, I believe you deserve to have a say in how your healthcare is delivered.

Your body deserves time. Your questions deserve answers. And your care should be built around your goals.

That’s why I practice differently.

And that’s why I believe this model allows me to provide the kind of personalized, one-on-one pelvic floor physical therapy that my patients deserve.

I hear from a lot of friends and patients that they have no clue what Pelvic PT entails. It’s a big barrier to people getting the help they need when they are scared to even try it. Here’s an idea of what to expect when you walk into my clinic. 

First, We Talk

We sit down and have a chat about your symptoms, your medical history, and how your concerns are affecting your everyday life. We talk about your goals, your worries, your life, your schedule, your body… all the things. 

Depending on what’s going on I’ll ask you about:

• Pelvic or abdominal pain
• Urinary frequency, urgency, or leakage
• Constipation or bowel symptoms
• Pain with intimacy
• Pregnancy or postpartum recovery
• Menstrual or pelvic symptoms
• Hip, back, or tailbone pain
• Pelvic pressure or heaviness
• Previous surgeries, injuries, or treatments

Some of these questions can feel personal. That’s completely normal. 

You don’t have to feel embarrassed. Pelvic health is a physical-health issue, and these questions help your therapist understand the bigger picture. It’s always up to you about how much you want to tell me, especially on day one!

The Assessment

After talking through your concerns, I will do a PT exam. 

This can include looking at your posture, breathing, movement, hips, abdomen, back, or other areas that may be contributing to your symptoms. This all starts with external things! An internal exam is not automatically required. If your therapist makes you feel like you HAVE to have this done, find a new therapist. Your therapist should explain why they recommend it, what it involves, and what you can expect before doing anything.

You have the right to ask questions, pause, or say no.

Your comfort and consent matter throughout the appointment. I ask permission MULTIPLE times. 

What About the Pelvic Floor Exam?

If an internal examination is appropriate for you and you agree to it, we talk through it beforehand. The goals of an internal exam are to assess things like muscle coordination, tension, strength, relaxation, tenderness, or how the pelvic floor muscles respond to movement and pressure.

And here’s something important:

Pelvic PT isn’t just about doing more Kegels.

For some people, the pelvic floor muscles may actually be too tense or have difficulty relaxing. In those cases, learning how to release and coordinate the muscles may be more important than strengthening them.

Treatment

My goal is always to have to you leave feeling better than when you walked in. My initial sessions are 1.5 hours so we have all the time to get to know each other, figure out what’s going on, and give me time to start your treatment! Treatment could include:

• Manual therapy like soft tissue mobilization
• cupping
• Graston
• Dry needling
• Visceral mobilization
• Education on anatomy and function
• Using ultrasound to look at your abs and pelvic floor muscles
• Movement and exericse

You’ll Leave With a Plan

By the end of your first appointment, I will know what direction to move toward. 

You might be given a few simple things to work on at home, such as:

• Breathing exercises
• Relaxation techniques
• Mobility exercises
• Posture or movement changes
• Bladder or bowel habits to track
• Pelvic floor coordination exercises
• Gentle strengthening

I see a lot of busy moms in my practice so I’m not one to send my patients home with a million exercises. Instead I try and carefully choose a few that would be the MOST beneficial for the time you have in your life. I work your routine into our plan, discuss how to make your gym time more efficient, and talk about what to be working on in your day to day. 

Your first visit is often about establishing a baseline and creating a treatment plan that makes sense for your body and your goals.

What Should You Wear?

Wear something comfortable that allows you to move easily.

You generally don’t need to dress differently just because you’re going to pelvic PT. If a pelvic exam is something we do I’ll provide you with a sheet (NOT a piece of paper) to cover up with!

A Few Things You Can Do Before Your Appointment

It can help to think about what you want to get out of pelvic PT.

Before you go, consider:

What symptoms are bothering me the most?

When did they start?

What makes them better or worse?

What activities am I avoiding because of them?

What would I love to be able to do without worrying about my symptoms?

Writing down a few notes can make the conversation easier—especially if you’re nervous or tend to forget things when you’re in an appointment.

Most Importantly: You’re in Control

You can ask questions.

You can request an explanation.

You can tell me if something hurts.

You can ask to stop.

And you can say no to an examination or technique.

A good pelvic physical therapist will work with you, not just on you.

So if you’re walking into your first appointment feeling nervous, take a breath. You don’t need to know anything about pelvic PT beforehand.

Your job is simply to show up, share what you’re experiencing, and start the conversation. You won’t be sorry!! 

Check out what all the buzz is about! 

Schedule An Appointment

To see my other blog posts go to

https://lacykellspt.blogspot.com

entering text

A few months ago I had a Physical Therapy student ask if she could interview me for a project she was working on. She was interested in Pelvic Health PT but didn’t know much about it. While they do have a class as part of their curriculum (taught by my amazing Pelvic Health mentor Brook Browning, PT) she hadn’t yet taken it. My passion for Pelvic Health is hard for me to keep bottled up, so I’m hoping she felt excited (instead of scared) to hear my thoughts!

Pelvic Health PT can be so helpful during pregnancy, to prepare for birth, and of course postpartum. We help with incontinence, pelvic pain, prolapse, diastasis abdominus (abdominal separation), constipation, fecal leaking, urgency of urine or stool, scar tissue, return to exercise, and SO MUCH MORE!!!

Here is the link to her article about how PT can be so helpful in the Fourth Trimester!!

Pelvic Floor Physical Therapy – How can it promote healing during the Fourth Trimester?

You can also find it on my Facebook page or Instagram!

The First Poop. 

We all know what I’m talking about right? That first poop after you give birth. It’s terrifying. It’s horrifying. It makes you sweaty with fear and dread that you are going to poop out your insides or rip open every stitch they just put in you. Or was this just me??

Maybe that was a little too much information for you but I’m just being honest. I’m pretty sure I was more traumatized by the idea of pooping after I delivered my first baby than I was from the actual delivery. I was so scared, in fact, that I had the nurse come in multiple times and talk me off the ledge over it. She didn’t actually come into the bathroom with me while I did it or anything, but she had to give me some pep talks. And all the stool softener.

Reality was not as scary as my imagination. I took the stool softeners they gave me and tried to go as soon as I had the urge. I think I was still taking Tylenol so it didn’t hurt that much, but the anticipation was rough.

Had I been a practicing Pelvic Health PT back in the day, I would have been on my game and been psyched about my first poop. However, I knew nothing. If you aren’t sure what exactly that is, click here for more info. For tips on how to make this first poop less scary, read the rest of this blog right over here on my blog!

Don’t forget to follow me on Facebook, Instagram, and YouTube for more tips and info on all things Pelvic Health!

I absolutely love teaching my Birth Body class to pregnant moms in our area. It’s probably my favorite thing to teach because there is so much to learn about our bodies and traditionally, no one tells us a whole lot. I teach my classes from the perspective of a Pelvic Floor PT so it’s a little different from other birth classes out there. That doesn’t mean mine is the best or that you shouldn’t go to others. It just means that there is room for several as you prepare yourself for birth. I have had first time moms as well as moms with lots of experience come and learn a lot from this class. Because I’m a PT, we focus on things like how to prepare your core, pelvic floor, muscles, soft tissues for birth. We talk about labor and delivery positions and the evidence for why you’d want to use which (depending on your body, your pain, your goals). We talk about things you can work on immediately after delivery to start healing your body well regardless of how you give birth. Me, I’ve had a vaginal birth and a Cesarean birth and could have used this after both deliveries. For a little more insight into what I wish I’d know, check out my blog post about my Cesarean recovery here or find out a little about why we should ALL have PT in our lives during pregnancy and postpartum here.

If you, a friend, a coworker, a family member is expecting, please consider sharing this class with them if you are in the Fayetteville/Pinehurst/Southern Pines area! Our next class will be taught at Mamaste Fit in Southern Pines on Saturday, January 26th. For more information contact me at lacykells@fayettevillepelvichealth.com, check out our Facebook event, or head to the Mamaste website to register!

As always, check out our other PT services here, check out our blog here, or find lots of fun information posted daily on Instagram @lacykellspt and Facebook at Lacy Kells PT, DPT!

My good friend and colleague Ashley Chandler recently delivered her second son. For some, that means a little less anxiety after having gone through this whole thing once before. However, that doesn’t mean things are all peaches and cream. I asked her to make some videos about motherhood, postpartum, recovery and how all of this feels second time around. I gave her no direction at all to see what issues felt most important to her and the first thing she wanted to talk about was postpartum depression and anxiety.

Postpartum depression and anxiety are not things that we choose to suffer from. They are chemical and/or hormonal imbalances that can make us feel awful, sad, insane, angry, scared, worried, even suicidal. They aren’t things we can just sleep away (though sleep deprivation does play into these issues). They are legitimate problems that moms can suffer from in the postpartum period, and it’s not always recognized. Very often moms don’t realize they may be dealing with these issues until they are past them. And let’s be honest, that is no way to live out the early postpartum days. Below is the video she made describing her experience with depression and anxiety. To learn a little more and find out if you are at risk for postpartum depression or anxiety, check out https://lacykellspt.blogspot.com/2019/12/postpartum-anxiety-and-depression.html.

See my Blogspot post on sit to stands as way to get a quick dose of exercise for when you are stuck at your desk. go to my services pages to find one that works for you.